We nearly brought our youngest child to the ER last night. Struck by an asthma attack in her sleep, she was gasping and vomiting at 9:40PM. This one came on frighteningly fast. By happenstance, I had been in her room checking her covers at 9:20PM and she was fine, resting comfortably and hugging the pillow in such a comical sprawl that I actually laughed out loud.

I was not laughing 20 minutes later. Not only was her condition frightening, the thought of rushing her to the ER to treat it filled me with dread. We’d been there before with her for the same problem. Once it led to a three-day hospital stay. It was best for her health, but such health care use takes a toll. Though sometimes it’s the lesser of two evils (if she needs the the ER, she needs the ER), nobody is happy about an ER visit. Nobody takes it lightly. If she can be treated effectively at home, that’s far better.

Two things saved us from an ER visit. One was a call to Aaron. It’s a long and unnecessary story why we called him and not the doctor on-call for our regular pediatrician. Suffice it to say we needed to talk to someone right away who would handle the problem appropriately, not pushing us into the ER if it wasn’t warranted, but also not ignoring the urgency of the problem. Aaron did a great job, advising us how to use the meds we had on hand. It took five minutes of his time and saved what might have otherwise been hundreds to thousands of dollars of, what turned out to be, unnecessary health care use.

The other hero of the night was our daughter. She’s a fighter, especially in her sleep (she really never woke up, despite the circumstances, and she recalls nothing about the episode this morning). Her little, nearly four-year-old body is strong, even when depleted of oxygen. She kicked and punched making delivery of medication impossible. However, she calmed down enough to take her meds when we told her if she doesn’t, she’ll have to go to the hospital. Somehow she heard that and it was enough. I’m impressed with the maturity of her decision under the circumstances and at her age.

The other things that made this successful home treatment possible were ample health literacy of her parents (we knew enough to know the options and knew enough to know when to reach out for more help) and ample supply of relevant medication and equipment. There are likely many people who have neither and, thus, would not have been able to steer such an event away from a trip to the hospital.

In other words, there was a high- and low-cost treatment option presented to us last night. That we were able to avail ourselves the low-cost one relied on a fair amount of health infrastructure and information transfer. From our own education, preparation, and insurance-financed supplies to the ability to obtain a timely, accurate phone consultation (itself the product of years of education, training, and practice), a lot of health care was actually used, but not the most intensive sort that could have been brought to bear.

At the time of ‘transaction’ — last night between 9:40PM and 11:00PM — no bills were generated. Nobody is getting paid. There was no thought of ‘skin in the game.’ But it was the best care for the situation. Maybe Aaron should send me a bill. For avoiding the ER, I’d happily pay it.